Telehealth Self-Management Support in Early Stroke Rehabilitation: A Feasibility Randomized Controlled Trial

Abstract

Background:

Skills to manage the chronic effect of stroke are often not sufficiently addressed in early stroke rehabilitation.

Objectives:

The study evaluated the feasibility of conducting a trial testing the efficacy of telehealth self-management support early in stroke recovery.

Methodology:

Process, resources, and scientific feasibility was assessed for a randomized controlled trial comparing the effect of motivational interviewing and a group-based self-management program to treatment-as-usual with first-time stroke patients. Data were analyzed using descriptive statistics, effect sizes, and thematic analysis.

Results:

Fifteen stroke patients were enrolled, and 10 completed the study (intervention n = 6). 100% attendance was achieved with technical support, reminders, and schedule flexibility. Participants were satisfied with the intervention and reported emotional benefits and gain of new insights. Perceived recovery showed moderate effect (r = 0.54).

Conclusion:

The findings support the feasibility of an efficacy trial as well as the potential benefit of integrating telehealth self-management support early in stroke rehabilitation.

Keywords

stroke rehabilitation randomized controlled trial community participation health promotion

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References

Banbury

Nancarrow

Dart

Gray

Parkinson

(2018). Telehealth interventions delivering home-based support group videoconferencing: Systematic review. Journal of Medical Internet Research, 20(2), e25. https://doi.org/10.2196/jmir.8090

Benjamin

E. J.

Virani

S. S.

Callaway

C. W.

Chamberlain

A. M.

Chang

A. R.

Cheng

Chiuve

S. E.

Cushman

Delling

F. N.

Deo

Muntner

(2018). Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Circulation, 137, e67–e492.

Bradley

E. H.

Curry

L. A.

Devers

K. J.

(2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772. https://doi.org/10.1111/j.1475-6773.2006.00684.x

Cella

Lai

J.-S.

Nowinski

C. J.

Victorson

Peterman

Miller

Bethoux

Heinemann

Rubin

Cavazos

J. E.

Reder

A. T.

Sufit

Simuni

Holmes

G. L.

Siderowf

Wojna

Bode

McKinney

Podrabsky

. . . Moy

(2012). Neuro-QOL: Brief measures of health-related quality of life for clinical research in neurology. Neurology, 78(23), 1860–1867. https://doi.org/10.1212/WNL.0b013e318258f744

Chen

Xiao

L. D.

Chamberlain

Newman

(2021). Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review. Journal of Clinical Nursing, 30(19–20), 2786–2807. https://doi.org/10.1111/jocn.15807

Clark

MacCrosain

Ward

N. S.

Jones

(2020). The key features and role of peer support within group self-management interventions for stroke? A systematic review. Disability and Rehabilitation, 42(3), 307–316. https://doi.org/10.1080/09638288.2018.1498544

Duncan

Reker

Kwon

Lai

S.-M.

Studenski

Perera

Alfrey

Marquez

(2005). Measuring stroke impact with the stroke impact scale: Telephone versus mail administration in veterans with stroke. Medical Care, 43(5), 507–515.

Freburger

J. K.

Fraher

E. P.

(2018). Community use of physical and occupational therapy after stroke and risk of hospital readmission. Archives of Physical Medicine and Rehabilitation, 99(1), 26–34.e5. https://doi.org/10.1016/j.apmr.2017.07.011

Hays

R. D.

Bjorner

J. B.

Revicki

D. A.

Spritzer

K. L.

Cella

(2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873–880. https://doi.org/10.1007/s11136-009-9496-9

10.

Hibbard Stockard

Mahoney

E. R.

Tusler

. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4 pt.1), 1005–1026.

11.

Kernan

W. N.

Viera

A. J.

Billinger

S. A.

Bravata

D. M.

Stark

S. L.

Kasner

S. E.

Kuritzky

Towfighi

, & American Heart Association Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; and Council on Peripheral Vascular Disease. (2021). Primary care of adult patients after stroke: A scientific statement from the American Heart Association/American Stroke Association. Stroke, 52(9), e558–e571. https://doi.org/10.1161/STR.0000000000000382

12.

Kroenke

Strine

T. W.

Spitzer

R. L.

Williams

J. B. W.

Berry

J. T.

Mokdad

A. H.

(2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. https://doi.org/10.1016/j.jad.2008.06.026

13.

Lee

Fischer

Zera

Robertson

Hammel

(2017). Examining a participation-focused stroke self-management intervention in a day rehabilitation setting: A quasi-experimental pilot study. Topics in Stroke Rehabilitation, 24(8), 601–607. https://doi.org/10.1080/10749357.2017.1375222

14.

Lee

Fogg

L. F.

Hammel

Baum

C. M.

Wolf

T. J.

(2018). Validation of the Participation Strategies Self-efficacy Scale (PS-SES). Disability & Rehabilitation, 40, 110–115. https://doi.org/10.1080/09638288.2016.1242172

15.

Lennon

McKenna

Jones

(2013). Self-management programmes for people post stroke: A systematic review. Clinical Rehabilitation, 27(10), 867–878. https://doi.org/10.1177/0269215513481045

16.

Mohr

D. C.

Spring

Freedland

K. E.

Beckner

Arean

Hollon

S. D.

Ockene

Kaplan

(2009). The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychotherapy and Psychosomatics, 78(5), 275–284. https://doi.org/10.1159/000228248

17.

Moral

R. R.

Torres

L. A. P.

de Ortega

L. P.

Larumbe

M. C.

Villalobos

A. R.

García

J. A. F.

Rejano

J. M. P.

, & Collaborative Group ATEM-AP Study. (2015). Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care. Patient Education and Counseling, 98(8), 977–983. https://doi.org/10.1016/j.pec.2015.03.008

18.

Obembe

A. O.

Eng

J. J.

(2016). Rehabilitation interventions for improving social participation after stroke: A systematic review and meta-analysis. Neurorehabilitation and Neural Repair, 30(4), 384–392. https://doi.org/10.1177/1545968315597072

19.

Pallant

(2011). SPSS survival manual: A step by step guide to data analysis using the SPSS program (4th ed.). Allen & Unwin. http://www.books24x7.com/marc.asp?bookid=45825

20.

Platz

(2019). Evidence-based guidelines and clinical pathways in stroke rehabilitation—An international perspective. Frontiers in Neurology, 10, Article 200. https://www.frontiersin.org/articles/10.3389/fneur.2019.00200

21.

Samson

L. W.

Tarazi

Turrini

Sheingold

(2021). Medicare beneficiaries’ use of telehealth in 2020: Trends by beneficiary characteristics and location (Issue Brief No. HP-202127; p. 34). Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. https://aspe.hhs.gov/sites/default/files/documents/a1d5d810fe3433e18b192be42dbf2351/medicare-telehealth-report.pdf

22.

Shrivastav

S. R.

Ciol

M. A.

Lee

(2022). Perceived community participation and associated factors in people with stroke. Archives of Rehabilitation Research and Clinical Translation, 4(3), Article 100210. https://doi.org/10.1016/j.arrct.2022.100210

23.

Singh

Nguyen

Hahn-Goldberg

Lewis-Fung

Smith-Bayley

Nelson

M. L. A.

(2022). A qualitative study exploring the experiences of individuals living with stroke and their caregivers with community-based poststroke services: A critical need for action. PLOS ONE, 17(10), Article e0275673. https://doi.org/10.1371/journal.pone.0275673

24.

Taylor

D. M.

Cameron

J. I.

Walsh

McEwen

Kagan

Streiner

D. L.

Huijbregts

M. P. J.

(2009). Exploring the feasibility of videoconference delivery of a self-management program to rural participants with stroke. Telemedicine and E-Health, 15(7), 646–654. https://doi.org/10.1089/tmj.2008.0165

25.

Tickle-Degnen

(2013). Nuts and bolts of conducting feasibility studies. The American Journal of Occupational Therapy, 67(2), 171–176. https://doi.org/10.5014/ajot.2013.006270

26.

Warner

Packer

Villeneuve

Audulv

Versnel

. (2015). A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: Self-management programs for stroke survivors. Disability and Rehabilitation, 37(23), 2141–2163. https://doi.org/10.3109/09638288.2014.996674

27.

Watkins

C. L.

Auton

M. F.

Deans

C. F.

Dickinson

H. A.

Jack

C. I. A.

Lightbody

C. E.

Sutton

C. J.

van den Broek

M. D.

Leathley

M. J.

(2007). Motivational interviewing early after acute stroke: A randomized, controlled trial. Stroke, 38(3), 1004–1009. https://doi.org/10.1161/01.STR.0000258114.28006.d7

28.

Watkins

C. L.

Wathan

J. V.

Leathley

M. J.

Auton

M. F.

Deans

C. F.

Dickinson

H. A.

Jack

C. I. A.

Sutton

C. J.

van den Broek

M. D.

Lightbody

C. E.

(2011). The 12-month effects of early motivational interviewing after acute stroke: A randomized controlled trial. Stroke, 42(7), 1956–1961. https://doi.org/10.1161/STROKEAHA.110.602227

29.

Wolf

T. J.

Baum

C. M.

Lee

Hammel

(2016). The development of the improving participation after stroke self-management Program (IPASS): An exploratory randomized clinical study. Topics in Stroke Rehabilitation, 23(4), 284–292. https://doi.org/10.1080/10749357.2016.1155278

30.

Wolf

T. J.

Koster

(2013). Perceived recovery as a predictor of physical activity participation after mild stroke. Disability and Rehabilitation, 35(14), 1143–1148. https://doi.org/10.3109/09638288.2012.720635